Search

To observe the structural changes of retina and choroid in patients with different degrees of myopia. We recruited 219 subjects with different degrees of myopia for best corrected visual acuity, computer refraction, intraocular pressure, axial length (AL), optical coherence tomography (OCT) imaging, and other examinations. Central macular retinal thickness (CRT), subfoveal choroidal thickness (SFCT), nasal retinal thickness (NRT), temporal retinal thickness (TRT), nasal choroidal thickness (NCT) and temporal choroidal thickness (TCT) were measured by optical coherence tomography. ImageJ software was used to measure the retinal area and choroidal area (CA), and Niblack was used to binarize all OCT images to measure the choroidal vessel area (CVA) and choroidal matrix area (CMA). We found that CRT, SFCT, NRT, TRT, NCT, TCT, CA, CVA, and CMA were significantly reduced in the pathological myopia (PM) group. AL was negatively correlated with NRT, SFCT, CMA, CVA and choroidal stromal index. There was a significant positive correlation between AL and choroidal vascular index. The choroidal vascular index in the PM group was significantly increased compared with the other groups. We established a univariate receiver operating curve to analyze the diagnostic value of all parameters for PM. Spherical equivalent, AL, SFCT, TCT, NCT, CA, CVA, and CMA had high diagnostic value for PM, among which CMA had the highest accuracy. There are changes in choroidal structure in adults with different degrees of myopia. Choroidal thickness, CVA and CMA decrease significantly with the increase of myopia, and are correlated with AL. The decrease of CMA has higher diagnostic value in myopia. [ABSTRACT FROM AUTHOR]

Pathological myopia (PM) is a severe ocular disease leading to blindness. As a traditional noninvasive diagnostic method, fundus color photography (FCP) is widely used in detecting PM due to its high fidelity and precision. However, manual examination of fundus photographs for PM is time-consuming and prone to high error rates. Existing automated detection technologies have yet to study the detailed classification in diagnosing different stages of PM lesions. In this paper, we proposed an intelligent system which utilized Resnet101 technology to multi-categorically diagnose PM by classifying FCPs with different stages of lesions. The system subdivided different stages of PM into eight subcategories, aiming to enhance the precision and efficiency of the diagnostic process. It achieved an average accuracy rate of 98.86% in detection of PM, with an area under the curve (AUC) of 98.96%. For the eight subcategories of PM, the detection accuracy reached 99.63%, with an AUC of 99.98%. Compared with other widely used multi-class models such as VGG16, Vision Transformer (VIT), EfficientNet, this system demonstrates higher accuracy and AUC. This artificial intelligence system is designed to be easily integrated into existing clinical diagnostic tools, providing an efficient solution for large-scale PM screening. [ABSTRACT FROM AUTHOR]

AIM: To evaluate the clinical effect of a new surgery technique (covering corneal stromal lenticule, CSL) for macular hole (MH) in pathological myopia. METHODS: This was a prospective non-randomized series case study. Fourteen eyes of 14 patients whose axial length were more than 29 mm and suffered from MH and macular hole retinal detachment (MHRD) were included in this study. All cases were treated with 25-gauge pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling, covering CSL and C3F8 gas tamponade. These cases were followed for 6mo, and the best-corrected visual acuity (BCVA), healing status of MH, the reattached rate of retinal detachment (RD), and reoperation rate were analyzed. RESULTS: All cases were successfully performed the surgery and the postoperative follow-up was completed. After surgery, MHs were healed in all 14 eyes (100%, 14/14) after assessed by optical coherence tomography. The reattachment of retina was achieved in all 6 eyes (100%, 6/6) with MHRD. BCVA was improved in 12 eyes (85.71%, 12/14), and had no significant change in 2 eyes (14.29%, 2/14). The overall mean BCVA was improved from 1.80±0.77 to 0.82±0.46 logMAR (F=10.46, P

Pathological myopia (PM) is one of the leading causes of blindness, especially in Asia. To identify the genetic risk factors of PM, a two‐stage genome‐wide association study (GWAS) and replication analysis in East Asian populations is conducted. The analysis identified LILRB2 in 19q13.42 as a new candidate locus for PM. The increased protein expression of LILRB2/Pirb (mouse orthologous protein) in PM patients and myopia mouse models is validated. It is further revealed that the increase in LILRB2/Pirb promoted fatty acid synthesis and lipid accumulation, leading to the destruction of choroidal function and the development of PM. This study revealed the association between LILRB2 and PM, uncovering the molecular mechanism of lipid metabolism disorders leading to the pathogenesis of PM due to LILRB2 upregulation. [ABSTRACT FROM AUTHOR]

Pathological myopia is a major cause of blindness among people under 50 years old and can result in severe vision loss in extreme cases. Currently, its detection primarily relies on manual methods, which are slow and heavily dependent on the expertise of physicians, making them impractical for large-scale screening. To tackle these challenges, we propose SMLS-YOLO, an instance segmentation method based on YOLOv8n-seg. Designed for efficiency in largescale screenings, SMLS-YOLO employs an extremely lightweight model. First, StarNet is introduced as the backbone of SMLS-YOLO to extract image features. Subsequently, the StarBlock from StarNet is utilized to enhance the C2f, resulting in the creation of the C2f-Star feature extraction module. Furthermore, shared convolution and scale reduction strategies are employed to optimize the segmentation head for a more lightweight design. Lastly, the model incorporates the Multi-Head Self-Attention (MHSA) mechanism following the backbone to further refine the feature extraction process. Experimental results on the pathological myopia dataset demonstrate that SMLS-YOLO outperforms the baseline YOLOv8n-seg by reducing model parameters by 46.9%, increasing Box mAP@0.5 by 2.4%, and enhancing Mask mAP@0.5 by 4%. Furthermore, when compared to other advanced instance segmentation and semantic segmentation algorithms, SMLS-YOLO also maintains a leading position, suggesting that SMLS-YOLO has promising applications in the segmentation of pathological myopia images. [ABSTRACT FROM AUTHOR]

Pathological myopia (PM) is a worldwide visual health concern that can cause irreversible vision impairment. It affects up to 20 crore population, causing social and economic burdens. Initial screening of PM using computer‐aided diagnosis (CAD) can prevent loss of time and finances for intricate treatments later on. Current research works utilizes complex models that are too resource‐intensive or lack explanations behind the categorizations. To emphasize the significance of artificial intelligence for the ophthalmic usage and address the limitations of the current studies, we have designed a mobile‐compatible application for smartphone users to detect PM. For this purpose, we have developed a lightweight model, using the enhanced MobileNetV3 architecture integrated with spatial attention (SA) and squeeze‐excitation (SE) modules to effectively capture lesion location and channel features. To demonstrate its robustness, the model is tested against three heterogeneous datasets namely PALM, RFMID, and ODIR reporting the area under curve (AUC) score of 0.9983, 0.95, and 0.94, respectively. In order to support PM categorization and demonstrate its correlation with the associated lesions, we have segmented different forms of PM lesion atrophy, which gave us intersection over union (IOU) scores of 0.96 and fscore of 0.97 using the same SA+SE inclusive MobileNetV3 as an encoder. This lesion segmentation can aid ophthalmologists in further analysis and treatment. The optimized and explainable model version is calibrated to develop the smartphone application, which can identify fundus image as PM or normal vision. This app is appropriate for ophthalmologists seeking second opinions or by rural general practitioners to refer PM cases to specialists. [ABSTRACT FROM AUTHOR]

Pathological myopia (PM) is a severe ocular disease leading to blindness. As a traditional noninvasive diagnostic method, fundus color photography (FCP) is widely used in detecting PM due to its high fidelity and precision. However, manual examination of fundus photographs for PM is time-consuming and prone to high error rates. Existing automated detection technologies have yet to study the detailed classification in diagnosing different stages of PM lesions. In this paper, we proposed an intelligent system which utilized Resnet101 technology to multi-categorically diagnose PM by classifying FCPs with different stages of lesions. The system subdivided different stages of PM into eight subcategories, aiming to enhance the precision and efficiency of the diagnostic process. It achieved an average accuracy rate of 98.86% in detection of PM, with an area under the curve (AUC) of 98.96%. For the eight subcategories of PM, the detection accuracy reached 99.63%, with an AUC of 99.98%. Compared with other widely used multi-class models such as VGG16, Vision Transformer (VIT), EfficientNet, this system demonstrates higher accuracy and AUC. This artificial intelligence system is designed to be easily integrated into existing clinical diagnostic tools, providing an efficient solution for large-scale PM screening.

A 45-year-old male presented with diminution of vision in the right eye (RE) for the past 2 weeks. He underwent sequential bilateral cataract surgery 25 years ago, with an intraocular lens in RE, which was his better eye. The left eye was aphakic with a thick fibrous membrane at the pupillary plane. Visual acuity was hand movement in the RE with the iris claw lens and total bullous retinal detachment (RD). The axial length with RD was 28.6 mm in RE and 29 mm in the left eye (LE). We did a vitrectomy with scleral imbrication, endolaser, fluid gas exchange, and tamponade in the RE. The LE developed RD subsequently, and he underwent similar surgical procedures in his LE. The best corrected visual acuity in his RE was 20/80, and that in the LE was 20/120 on follow-up. RD with staphyloma is a surgical challenge as the thin atrophic retina at the posterior pole fails to conform to the concavity of staphyloma. Vitrectomy with tamponade alone does not take care of staphyloma and has more chances of recurrent detachment or persistent fluid at the posterior pole. Scleral imbrication shallows the staphyloma cavity and shortens the axial length, thereby giving a good surgical outcome. [ABSTRACT FROM AUTHOR]

AIM: To compare the efficacy of different dosing regimens of conbercept in the treatment of pathological myopic choroidal neovascularization(CNV).METHODS: Prospective clinical study. Totally 42 patients(42 eyes)who were diagnosed with pathological myopic CNV in our hospital from January 2019 to January 2022 were selected in the study. According to two different initial dosing regimens, the patients were divided into 1+pro re nata(PRN)group, with 20 patients(20 eyes), and 3+PRN group with 22 patients(22 eyes). The patients in the 1+PRN group were given one intravitreal injection and then given PRN, the patients in the 3+PRN group were given intravitreal injection once a month for 3 mo and then given PRN. Followed-up for 12 mo after initial treatment, the best corrected visual acuity(BCVA), central macular thickness(CMT), CNV area and injection times were compared between the two groups.RESULTS: The BCVA was improved, CMT was decreased, and CNV area was reduced at 1, 3, 6, and 12 mo after the initial treatment(P0.05). The average injection in the 1+PRN group was significantly less than that of the 3+PRN group [2(1, 3)times vs 3(3, 4)times, P

Abstract Background Macular retinoschisis (MRS) and myopic macular neovascularization (mMNV) are both potentially blinding complications of high myopia. In this case report, we highlight the progression of MRS after intravitreal anti-vascular endothelial growth factor (anti-VEGF) treatment for mMNV, as well as an extensive review of the literature on this topic. Case description A 49-year-old woman presented with two weeks of recent onset blurring and metamorphopsia in her right eye. She had high myopia in both eyes (right eye − 20/60 with − 16D, left eye − 20/20 with − 13D). Slit-lamp ophthalmoscopy found a normal anterior segment in both eyes. On fundus examination, features of pathological myopia with posterior staphyloma and peripapillary atrophy were observed in both eyes. An active mMNV, as well as intraretinal fluid, minimal perifoveal inner and outer MRS, and focal posterior vitreous traction along the inferotemporal retinal arcade, were detected on optical coherence tomography (OCT) of the right eye. The patient received an intravitreal injection of Aflibercept (2 mg/0.05 ml). Results OCT scans at two- and four-month follow-up visits revealed regressed mMNV with a taut epiretinal membrane, progressive worsening of outer MRS, and the development of multiple perifoveal retinal detachment inferior to the fovea. Pars plana vitrectomy surgery was performed for the progressive MRS with good anatomical (resolved MRS) and functional outcome (maintained visual acuity at 20/60) at the last one-month post-surgery visit. Conclusion Intravitreal anti-VEGF injections for mMNV can cause vitreoretinal interface changes, exacerbating MRS and causing visual deterioration. Vitrectomy for MRS could be one of several treatment options.

Purpose: To identify risk factors influencing visual outcomes in patients with pathological myopia-associated choroidal neovascularization (PM-CNV) following intravitreal injections of conbercept. Methods: A total of 86 eyes from 86 patients received intravitreal conbercept in a 1 + PRN regimen. After the initial injection, patients were followed for 12 months. They were categorized into two groups based on their 12-month visual acuity change: those who achieved greater than a one-line improvement in BCVA (improved group; n = 65) and those who experienced a one-line or lesser improvement or a decrease in BCVA (non-improved group; n = 21). Results: Over the 12-month period, the mean BCVA in the improved group significantly improved from 0.82 to 0.41 LogMAR. In the non-improved group, BCVA changed from 1.24 to 1.09 LogMAR. Similarly, the mean CRT decreased from 426.21 μm at baseline to 251.56 μm at 12 months in the improved group, and from 452.47 to 382.45 μm in the non-improved group. Multivariable logistic regression analyses revealed that older age (OR 1.287; 95% CI 1.019–1.625; P = 0.034), poorer baseline BCVA (OR 6.422; 95% CI 1.625–25.384; P = 0.008), the presence of subfoveal CNV (OR 4.817; 95% CI 1.242–18.681; P = 0.023), and organized interlacing patterns of CNV morphology (OR 5.593; 95% CI 1.397–22.392; P = 0.015) emerged as independent risk factors correlated with worsened visual prognosis following intravitreal conbercept injections. Conclusions: Conbercept demonstrates significant efficacy and safety in treating PM-CNV. Key factors influencing visual recovery post-treatment include older age, poorer baseline BCVA, the presence of subfoveal CNV, and organized interlacing patterns of CNV morphology. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the safety and efficacy of intravitreal injections of 0.5 mg conbercept in patients with choroidal neovascularization secondary to pathological myopia (pmCNV). Methods: The 177 pmCNV patients were randomly assigned in a 3:1 ratio to receive conbercept or sham injection, respectively. The conbercept group receive conbercept intravitreal injections administered on a pro re nata (PRN) basis after 3 monthly loading doses. The sham group received three consecutive monthly sham injections and then one conbercept injection followed by PRN conbercept intravitreal injections. Results: At month 3, the mean BCVA for the two groups were improved by 12.0 letters (conbercept group, from 54.05 letters to 66.05 letters) and 0.6 letters (sham group, from 49.77 letters to 50.33 letters), respectively (p < 0.001). The mean central retinal thickness (CRT) at month 3 in the two groups decreased 62.0 μm (conbercept group, from 348.90 μm to 286.18 μm) and 4.4 μm (sham group, from 347.86 μm to 343.47 μm) (p < 0.001). At month 9, the mean BCVA improved by 13.3 letters in the conbercept group and 11.3 letters in the sham group. The mean CRT decreased 73.6 μm in the conbercept group and 55.9 μm in the sham group (p < 0.001). The most common ocular adverse events were associated with intravitreal injections, such as conjunctival haemorrhage and increased intraocular pressure. Conclusion: Intravitreal injections of 0.5 mg conbercept provided improvement in visual and anatomical outcomes in pmCNV patients with low rates of ocular and nonocular safety events. [ABSTRACT FROM AUTHOR]

Background: Macular retinoschisis (MRS) and myopic macular neovascularization (mMNV) are both potentially blinding complications of high myopia. In this case report, we highlight the progression of MRS after intravitreal anti-vascular endothelial growth factor (anti-VEGF) treatment for mMNV, as well as an extensive review of the literature on this topic. Case description: A 49-year-old woman presented with two weeks of recent onset blurring and metamorphopsia in her right eye. She had high myopia in both eyes (right eye − 20/60 with − 16D, left eye − 20/20 with − 13D). Slit-lamp ophthalmoscopy found a normal anterior segment in both eyes. On fundus examination, features of pathological myopia with posterior staphyloma and peripapillary atrophy were observed in both eyes. An active mMNV, as well as intraretinal fluid, minimal perifoveal inner and outer MRS, and focal posterior vitreous traction along the inferotemporal retinal arcade, were detected on optical coherence tomography (OCT) of the right eye. The patient received an intravitreal injection of Aflibercept (2 mg/0.05 ml). Results: OCT scans at two- and four-month follow-up visits revealed regressed mMNV with a taut epiretinal membrane, progressive worsening of outer MRS, and the development of multiple perifoveal retinal detachment inferior to the fovea. Pars plana vitrectomy surgery was performed for the progressive MRS with good anatomical (resolved MRS) and functional outcome (maintained visual acuity at 20/60) at the last one-month post-surgery visit. Conclusion: Intravitreal anti-VEGF injections for mMNV can cause vitreoretinal interface changes, exacerbating MRS and causing visual deterioration. Vitrectomy for MRS could be one of several treatment options. [ABSTRACT FROM AUTHOR]

Abstract Pathological myopia (PM) is one of the leading causes of blindness, especially in Asia. To identify the genetic risk factors of PM, a two‐stage genome‐wide association study (GWAS) and replication analysis in East Asian populations is conducted. The analysis identified LILRB2 in 19q13.42 as a new candidate locus for PM. The increased protein expression of LILRB2/Pirb (mouse orthologous protein) in PM patients and myopia mouse models is validated. It is further revealed that the increase in LILRB2/Pirb promoted fatty acid synthesis and lipid accumulation, leading to the destruction of choroidal function and the development of PM. This study revealed the association between LILRB2 and PM, uncovering the molecular mechanism of lipid metabolism disorders leading to the pathogenesis of PM due to LILRB2 upregulation.

Abstract Background To compare the recurrence of myopic choroidal neovascularization (mCNV) based on the neovascular signal of mCNV around the perforating scleral vessel (PSV). Methods A consecutive series of naïve patients with mCNV accepted anti-VEGF therapy with a minimum 12-month follow-up period. The neovascular signal relationship between PSV and mCNV were classified into the presence of neovascular signal of CNV around PSV or not. The recurrence of mCNV, best-corrected visual acuity (BCVA), hyperreflective foci height, CNV area and CNV flow area were analyzed between two groups. Results Neovascular signal of CNV around PSV was detected in 20 eyes (39.2%). The one-year recurrence rate in the group with neovascular signal of CNV around PSV was significantly higher than that in the group without neovascular signal of CNV around PSV (P = 0.045). The recurrence time in the group with neovascular signal around PSV was shorter than that in the group without neovascular signal around PSV (P = 0.030). Cox proportional hazard model showed that the presence of neovascular signal of CNV around PSV [hazard ratio (HR): 2.904] and subfoveal choroidal thickness ≤ 50 μm (HR: 0.368) were risk factors for recurrence of mCNV. In the group with neovascular signal around PSV, the BCVA was worse (P = 0.024) and the CNV flow area was more unstable (P = 0.027) after therapy. Conclusions PSV was commonly detected in patients with mCNV. The presence of neovascular signal of CNV around PSV was prone to recur with a shorter time in mCNV patients.

PurposeTo illustrate the characteristics of perforating scleral vessels in macular regions between mCNV eyes and contralateral eyes in unilateral mCNV patients.MethodsThis was a retrospective study that included patients with unilateral naive mCNV. The study aimed to identify and analyze the distribution of perforating scleral vessels (PSVs) in the macular region of mCNV eyes and contralateral eyes. The central macular choroidal thicknesses (mChT) were measured using optical coherence tomography angiography (OCTA). The grades of myopic atrophic maculopathy (MAM) and macular myopic diffuse chorioretinal atrophy (DCA) were evaluated within groups. The number of PSVs and mChT were compared between contralateral and mCNV eyes based on the grade of DCA. The ROC curves were utilized to explore the diagnostic indexes for mCNV.ResultsA total of 102 eyes from 51 patients with unilateral mCNV were included. There was no significance in the severity of MAM or the grade of DCA between mCNV eyes and contralateral eyes (p = 0.074, p = 0.054, respectively). The mean number of PSVs in mCNV eyes was fewer than the contralateral eyes [1.00 (1.00–2.00) vs. 2.00 (0.75–3.00), p = 0.030]. The mChT in mCNV eyes was thinner than the contralateral eyes [36.00 (25.00–53.75) μm vs. 46.00 (31.00–75.25) μm, p = 0.001]. The mean grade of DCA in mCNV eyes was higher than that in contralateral eyes [3.00 (3.00–3.00) vs. 3.00 (2.00–3.00), p = 0.004]. When DCA involved the macular region, there were more PSVs in contralateral eyes than in mCNV eyes [1.50 (1.00–2.00) vs. 2.00 (1.00–3.00), p = 0.042]. Similarly, when DCA involved the foveal region, there were more PSVs in contralateral eyes than in mCNV eyes [1.50 (1.00–2.00) vs. 3.00 (2.00–4.00), p = 0.004]. The grade of DCA and mChT were valuable factors for predicting mCNV eyes (AUC = 0.6566, p = 0.021; AUC = 0.6304, p = 0.029; respectively). When the extent of DCA exceeded the foveal region, the count of PSVs was a good diagnostic factor for predicting mCNV (AUC = 0.7430, p = 0.003).ConclusionThe mean amount of PSVs was significantly lower in the mCNV eyes compared to the contralateral eyes. When the extent of DCA exceeded the foveal region, the count of PSVs was a good diagnostic factor for predicting mCNV. Myopic eyes with a higher grade of DCA and a thinner mChT were more likely to develop mCNV.

AIM: To observe the multimodal image features of dome-shaped macula(DSM)with subretinal fluid(SRF)in adolescents with high myopia, and investigate its typical features and identification methods.METHODS: This is a retrospective study. A total of 21 adolescent patients(39 eyes)who were diagnosed as DSM in high myopic eyes with SRF in the macula area in our hospital from January 2021 to May 2022 were selected. All patients underwent color fundus photography(CFP), fundus autofluorescence(FAF), spectral-domain optical coherence tomography(SD-OCT), optical coherence tomography angiography(OCTA)and electro oculography(EOG). Among them, 18 patients(36 eyes)underwent fundus fluorescein angiography(FFA), and they were followed-up for 12mo to record the change of the central macular thickness(CMT).RESULTS: Fundus examination showed tessellated retina in affected eyes, and the deposition of granular material could be seen in the fovea of the macular area. SD-OCT showed a dome-like bulge of the whole layer in the macular area, localized detachment of the subfoveal nerve epithelial layer, the medium and high reflection attachment on the inner surface of the outer membrane, and the heterogeneous reflection of the retinal pigment epithelium(RPE)layer. FAF showed a mild “bull's eye sign” change in the macular area. FFA showed granular transmitted fluorescence around the foveal avascular zone. En face of OCTA could see a clear boundary of the neuroepithelial detachment zone. When the tangential line corresponds to the ellipsoid zone-RPE layer, the granular high reflection in different sizes scattered in the neuroepithelial detachment zone could be seen, and no obvious choroidal neovascularization(CNV)was formed. During the follow-up of OCTA, SRF in the macular area can be spontaneously increased or absorbed irregularly. EOG indicates that the ratio of light peak to dark trough(LP/DT, i.e. Arden ratio)was normal, with an Arden ratio>1.55. CMT at 1, 3, 6, 12mo(247.10±13.03, 246.62±12.23, 248.05±14.00, 247.92±11.66 μm)during follow-up period were compared with baseline(246.95±11.46 μm), and the difference was not statistically significant(F=0.144, P=0.965).CONCLUSION: Multimodal imaging is helpful in the clinical diagnosis of DSM with SRF in the macula area in high myopic eyes of adolescents, and plays an important role in the differential diagnosis of the early stage of typical Best disease.

Background/aim: This study aimed to examine changes in the thickness of individual macular retinal layers in eyes with pathological myopia (PM) and to compare the thickness of each retinal layer between the PM and control groups to gain insights into retinal perfusion. Materials and methods: The study included 51 eyes in the PM group and 51 eyes in the control group. Optical coherence tomography (OCT) was used to measure the thickness of each retinal layer in the central fovea, parafoveal, and perifoveal regions. Optical coherence tomography angiography (OCT-A) was used to evaluate the retinal capillary density. Results: In the PM group, the retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), and inner nuclear layer (INL) were thicker than in the control group (p = 0.004, p = 0.027, p = 0.020, and p < 0.001, respectively), whereas the outer nuclear layer (ONL) and photoreceptor layer (PRL) were thinner (p = 0.001 and p = 0.003, respectively). In other regions, the RNFL was thicker in the myopic group, whereas the GCL, IPL, INL, and ONL were thinner. OCT-A did not reveal any significant difference between the groups in terms of radial capillary plexus density (p = 0.381); however, the densities of the other plexuses were lower in the PM group. Conclusions: The results showed alterations in the thickness of retinal layers and capillary plexus density in PM. Thus, assessment of the thickness of individual retinal layers may serve as an indicator of vascular diseases that affect the circulation of the retina and choroid. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the clinical efficacy of conbercept 1 + pro re nata (PRN) (i.e., reinjection as needed after one injection) and 3 + PRN (reinjection as needed after 3 months of injection) regimens in choroidal neovascularization secondary to pathological myopia (PM-CNV). Methods: From 06/2019 to 06/2020, 65 patients (65 eyes) confirmed with PM-CNV were included in this retrospective study. Intravitreal injection of 0.5 mg conbercept was conducted either with the 1 + PRN or 3 + PRN strategy. Patients were followed up for 12 months. The best-corrected visual acuity (BCVA), central retinal thickness (CRT), CNV lesion leakage area, the number of injections, and postoperative adverse reactions were observed. Results: The mean age of the patients was 42.10 ± 4.69 years, and the average diopter was − 11.26 ± 2.97D. The BCVA at month 3 in the 3 + PRN (n = 30) group was lower than in the 1 + PRN (n = 35) group (P < 0.001). The CRT at month 3 in the 3 + PRN group was lower than in the 1 + PRN group (P < 0.001). After 12 months, there were no differences in the BCVA and CRT between the two groups (P > 0.05). The number of injections was less in 1 + PRN than in 3 + PRN (2.14 ± 1.06 vs. 3.37 ± 0.76, P < 0.001) at 12 months. No serious treatment-related ocular complications or serious systemic adverse events were found. Conclusion: The 1 + PRN and 3 + PRN strategies of intravitreal injection of conbercept are effective in treating PM-CNV. The 1 + PRN regimen required fewer injections, and it might be more suitable for the treatment of PM-CNV. [ABSTRACT FROM AUTHOR]

Abstract Background We retrospectively evaluate the long-term efficacy and safety of trabeculotomy glaucoma surgery in treating open-angle glaucoma (OAG) in eyes with high myopia (HM). Methods This study included 20 eyes with HM (axial length ≥ 26.5 mm) and OAG; age, preoperative IOP (intraocular pressure), and sex-matched 20 non-HM eyes (axial length

Abstract This study aimed to investigate the awareness of high and pathological myopia among patients with high myopia. A cross‐sectional multicenter survey involving both physicians and patients was conducted between February and April 2021. The outpatient education status, doctors' expectations toward patient education, patients' awareness of high/pathological myopia, and their access to relevant knowledge were inquired, and the proportions of patients with myopia, including high and pathological myopia, were assessed. In total, the survey involved 6975 physicians and patients with myopia from 161 medical institutions in China. The prevalence of high myopia among patients was 11.3%, with 22.59% having pathological myopia. Among those with pathological myopia, 22.45% experienced high myopia complications. Approximately 48.7% of the physicians believed that patients had only a vague idea about high/pathological myopia, with certain misconceptions. Additionally, most outpatients (61.4%) had no access to specialized staff for patient education. Patients' preferences and requirements for online ophthalmology information varied based on family background, medical history, and cognition toward myopia. This study demonstrated that the awareness level among patients with myopia regarding high and pathological myopia is currently insufficient. Therefore, it is important to enhance education efforts to reduce the incidence of adverse outcomes.

Objective: To compare the morphological and quantitative changes in pathological myopia (PM) and the perioperative changes in posterior scleral reinforcement (PSR) using three-dimensional magnetic resonance images (3D MRI).Methods: A total of 49 patients with high myopia (HM; 98 eyes), 15 with pathological myopia (PM; 19 eyes), and 10 without high myopia (NORM; 20 eyes) were recruited between September 2019 and July 2021. The patients underwent measurements of refractive error and axial length, as well as 3D MRI of the eyeball. Python was used to analyze the 3D MRI images, calculate the vitreous volume, establish a topography of the height of the eyeball posterior surface, and calculate the rate of change in height (H). For the PM group undergoing PSR, changes in vitreous volume and the highest point of the eyeball posterior surface in four quadrants (temporal, subtemporal, nasal, and subnasal) were compared before and after PSR.Results: The vitreous volume was smaller in the NORM group compared to the HM and PM groups (p < 0.01). The PM group had a larger volume than the HM group (p < 0.01). The H for the PM group was higher than that of the NORM and HM groups (p < 0.01). After PSR in the PM group, the total vitreous volume, as well as the volume in the subnasal and supratemporal quadrants, decreased (p < 0.05). Additionally, the highest point of the eyeball’s posterior surface was generally shifted to the upper nasal side. Finally, the shape and position of the scleral band after PSR were plotted.Conclusion: 3D MRI is capable of a quantitative description of the eyeball morphology in PM and PSR. It allows for precise calculations of changes in vitreous volume and the H of the posterior surface. It also facilitates a meticulous analysis of the specific details of the scleral band following PSR.

Purpose: To assess the clinical outcomes of two intravitreal injection regimens of Conbercept used to treat choroidal neovascularization secondary to pathological myopia (PM-CNV). Methods: A total of 72 eyes of 72 patients were treated: 39 eyes received a single injection followed by treatment pro re nata (1 + PRN); 33 eyes first received 3 consecutive monthly injections (3 + PRN) then followed by PRN. After initial injection, patients were followed up for 12 months. Results: The mean age of 72 patients was 45.3 ± 5.1 years, with the mean diopter of -10.62 ± 3.24D. The best corrected visual acuity (BCVA) was 0.86 ± 0.23 LogMAR with 1 + PRN and 0.90 ± 0.19 LogMAR with 3 + PRN at baseline (P = 0.422), 0.36 ± 0.07 and 0.33 ± 0.05 LogMAR at month 3 (P = 0.026); and 0.33 ± 0.03 and 0.32 ± 0.02 LogMAR at month 12 (P = 0.096). The central retinal thickness (CRT) was 333.5 ± 22.7 μm with 1 + PRN and 341.2 ± 20.9 μm with 3 + PRN at baseline (P = 0.139), 281.53 ± 10.28 and 273.15 ± 13.24 μm at month 3 (P = 0.004); 266.83 ± 8.14 and 264.91 ± 9.27 μm at month 12 (P = 0.350). The number of injections in the 1 + PRN group was significantly lower than that observed in the 3 + PRN group (2.15 ± 1.06 versus 3.36 ± 0.74; P < 0.001). During the follow-up, no serious ocular complications and adverse reactions related to Conbercept and injections occurred. Conclusions: Both injection regimens resulted in similar visual outcomes in PM-CNV patients. The 1 + PRN regimen had fewer injections and might be more suitable in this patient population. [ABSTRACT FROM AUTHOR]

Background: Myopia has become a worldwide problem that endangers public health and adds a serious socioeconomic burden. Current research has focused on the pathogenesis and manifestations of pathological myopia (PM). However, few studies have been conducted on the spontaneous activity of the patient's brain. Purpose: To study the potential brain network activity in patients with PM by the degree centrality (DC) method. Materials and Methods: This experiment included 15 PM patients and 15 healthy controls (HCs). Every participant experienced a resting‐state functional magnetic resonance imaging (rs‐fMRI) scan. Receiver operating characteristic (ROC) curve analysis was used to distinguish between PM patients and HCs. Correlation analysis was used to explore the relationships between mean DC values and clinical performance in different brain regions. Results: It showed that patients with PM had lower DC values in the right fusiform gyrus (FR) and right cingulate (CAR). The ROC curve was used to indicate the accuracy of the correlation. It showed that in PM group, left best corrected visual acuity (BCVA‐L) and right best corrected visual acuity (BCVA‐R) were negatively correlated with the DC value of FR. Conclusion: The occurrence of PM is mainly related to the abnormal activity of the fusiform and cingulum. DC value might be used as a biological marker of abnormal brain activity in PM patients. [ABSTRACT FROM AUTHOR]

Choroidal neovascularization (CNV) is a severe complication observed in individuals with pathological myopia (PM). Our hypothesis is that specific metabolic alterations occur during the development of CNV in patients with PM. To investigate this, an untargeted metabolomics analysis was conducted using gas chromatography–mass spectrometry (GC–MS) and liquid chromatography–mass spectrometry (LC–MS) on aqueous humor (AH) samples obtained from meticulously matched PM patients, including those with CNV (n = 11) and without CNV (n = 11). The analysis aimed to identify differentially expressed metabolites between the two groups. Furthermore, the discriminative ability of each metabolite was evaluated using the area under the receiver operating characteristic curve (AUC). Enriched metabolic pathways were determined using the KEGG and MetaboAnalyst databases. Our results revealed the detection of 272 metabolites using GC–MS and 1457 metabolites using LC–MS in AH samples. Among them, 97 metabolites exhibited significant differential expression between the CNV and non-CNV groups. Noteworthy candidates, including D-citramalic acid, biphenyl, and isoleucylproline, demonstrated high AUC values ranging from 0.801 to 1, indicating their potential as disease biomarkers. Additionally, all three metabolites showed a strong association with retinal cystoid edema in CNV patients. Furthermore, the study identified 12 altered metabolic pathways, with five of them related to carbohydrate metabolism, suggesting their involvement in the occurrence of myopic CNV. These findings provide possible disease-specific biomarkers of CNV in PM and suggest the role of disturbed carbohydrate metabolism in its pathogenesis. Larger studies are needed to validate these findings. [ABSTRACT FROM AUTHOR]

Abstract Purpose Myopic scleral pit (MSP) is a rare physical sign of pathological myopia (PM). The aim of this study was to summarize the clinical characteristics of MSP and analyze its correlation with PM. Methods Eight cases with PM and MSP were enrolled in this study. Comprehensive ophthalmic examinations, including subjective refraction, slit-lamp biomicroscope, intraocular pressure, fundus photographs, A- and B-scan ultrasonography and spectral-domain optical coherence tomography, were performed. Results All the patients had a long history of PM with visual impairment, long axial length, and myopia-related fundus degeneration. Mean axial length was 31.48 ± 2.17 mm. Mean size of MSP was 0.69 ± 0.29 optic disc diameter (PD). Mean logMAR BCVA was 1.21 ± 0.88 logMAR. Spearman correlation analysis showed that the logMAR BCVA had no correlation with the size of pits (P = 0.34). Fundus examination revealed a focal pale concave located in the sclera exposed area of retinal choroid atrophy was found in all cases. OCT showed a deep scleral pit where the retinal choroid was thin or absent, without retinal sensory detachment or sensory defect. Conclusions This study identified a rare scleral lesion in all eight individuals with PM, which was termed “myopic scleral pit”. This phenomenon is different from focal choroidal excavation and posterior staphyloma.

High myopia is the main cause of visual impairment in the world. With the development of society, the myopia rate is increasing year by year. The development of high myopia is closely related to the progressive extension of the eye axis, and a series of fundus changes will inevitably occur with the extension of the eye axis, such as comus, lacquer cracks, choroidal neovascularization, macular choroidal atrophy, retinal detachment, posterior scleral staphyloma, etc. At present, characterized by younger age and high degree, myopia has become the main cause of blindness in China. This paper briefly summarizes the latest research on the morphological changes of the optic disc, macula, retina, choroid and sclera of high myopia, aiming to provide references for the development of intelligent prediction models, clinical diagnosis and further research on the treatment measures in combination with the fundus morphology of high myopia.

Aim We aimed to compare the anatomical and visual response of newly diagnosed choroidal neovascularization (CNV) secondary to pathological myopia or age-related macular degeneration with relatively poor initial vision to treatment with three intravitreal injections of ranibizumab. Patients and methods This prospective, comparative study included 29 eyes of 29 patients newly diagnosed with subfoveal active CNV, either secondary to age-related macular degeneration (AMD-CNV, 15 eyes) or to pathological myopia, that is, myopic CNV (MCNV, 14 eyes). All patients had an initial best-corrected visual acuity (BCVA) equal to or worse than 1.00 Log Mar. Patients received three intravitreal injections of 0.50 mg ranibizumab on a monthly basis. Patients were evaluated before injections and one month after each injection for BCVA and optical coherence tomography-measured retinal parameters: central macular thickness, total volume, and average thickness (AT). Amsler’s chart was used to detect scotomas and metamorphopsias. Results One month after the three injections, a significant improvement was noted in the two groups in central macular thickness, total volume, and AT. The improvement was significantly better in AT of the AMD group. The mean BCVA improved significantly in the AMD group only as patients either improved or remained stationary, whereas in the MCNV group, 21% of patients deteriorated, which affected the significance of the overall mean of improvement (P=0.7823); the difference in the overall mean was insignificant. Despite that, almost half of the patients in each group had their visual acuity improved by an average of 9.5 letters in AMD and 10.7 in MCNV. Conclusion Naïve AMD-CNV and MCNV of initially poor VA can get significant improvement in all optical coherence tomography-measured retinal parameters following a three-injection course of ranibizumab on a monthly basis. VA improvement is more predictable in AMD, as no patients deteriorated after the injections, yet the overall difference in VA improvement between groups was insignificant.

Abstract Purpose We aimed to investigate the longitudinal change in the number of surgically operated myopic traction maculopathies (MTM) cases at a tertiary eye centre. Methods A retrospective study of all consecutive cases of surgically operated MTM over 12 years (2009-2020) was conducted in a myopia prevalent region. We compared outcomes among three groups: (1) myopic macular hole (MH), (2) myopic macular hole with retinal detachment (MHRD), and (3) myopic foveoschisis with retinal detachment (MFRD). Results Fifty-one cases were included in the study (8 cases of MH, 33 cases of MHRD and 10 cases of MFRD). The overall mean age was 63.8 +/- 8.7 with a female preponderance (2:1). The mean age of the MH group (58.6) was significantly younger than the MHRD group (64.2) and MFRD group (66.6) (p = 0.02). Subgroup analysis using ATN classification did not show its correlation with both visual improvement and anatomical success. When comparing the first 6-year period (2009-2014) with the second 6-year period (2015-2020), there was a significant increase in the number of cases (p = 0.01). Conclusion We observe an increase in the number of surgically operated MTM. This follows the trend of the global rise in the prevalence of myopia and baby boomers entering retirement.

Abstract Introduction To investigate the feasibility and safety of scleral ultraviolet A (UVA) cross-linking (scleral CXL) on pathologically blindness. Methods This was a prospective, observational clinical study. Five patients with monocular blindness due to pathological myopic maculopathy were enrolled. Eyes with best corrected visual acuity (BCVA) under 0.05 were defined as experimental eyes. The fellow eyes were defined as control eyes. Patients first underwent posterior scleral reinforcement (PSR) surgery in the control eye. Thereafter, scleral CXL surgery was performed in the experimental eye on the same day. Visual acuity, BCVA, slit lamp biomicroscopic examination, intraocular pressure measurement, corneal specula microscopies, axis length measurement, funduscopy with pupil dilation, color fundus photography, full-field flash electroretinography, optical coherence tomography, and color Doppler flow imaging were performed at baseline, 1 week, 1 month, 3 months, 6 months, and 12 months after surgery. Results No signs of inflammation were observed after operation and throughout the follow-up period. Retinoschisis was improved, while choroidal neovascularization fibrosis and retinal and choroidal atrophy were unchanged after scleral CXL. There were no statistically significant differences in the ophthalmic artery, central retinal artery, and posterior ciliary artery parameters of color Doppler flow imaging or in retinal thickness, within experimental and control eyes, at baseline, 1 week, 1 month, 3 months, or 12 months (P > 0.05). Conclusions This pilot study verified the feasibility and safety of scleral CXL on human blindness. The UVA-CXL on the sclera of human eyes seems to have the same effect as PSR in preventing progressive pathological myopia in the future. Trial Registration Chinese Clinical Trial Registry (ChiCTR2100042422).

AIM: To observe the long-term clinical efficacy of intravitreal injections of conbercept, a novel vascular growth factor inhibitor, for the treatment of pathological myopia choroidal neovascularization (PM-CNV). METHODS: A total of 67 eyes (from 67 patients; mean age, 54.90±12.7y) with PM-CNV were retrospectively researched. Based on the different schemes used for the administration of the drug, the patients were divided into two groups: group A (n=35; average age, 53.31±13.6y; average diopter, 9.25±1.72 D), which received only one injection of pro re nata (PRN; 1+PRN regimen), and group B (n=32; average age, 56.49±11.8y; average diopter, 9.63±2.24 D), which received one injection per month for 3mo (3+PRN regimen). Best-corrected visual acuity (BCVA) analysis, intraocular pressure (IOP) examination, slit-lamp microscopy, fundus examination and optical coherence tomography were performed at each follow-up. The recurrence and treatment times of CNV were recorded. The patients were followed up for at least 12mo. RESULTS: The BCVA was increased in 29 eyes (82.9%) in group A and 30 eyes (93.75%) in group B; no increase or decrease was observed in 6 (17.1%) and 2 (6.25%) eyes in groups A and B, respectively. The BCVA (logMAR) values before treatment (0.67±0.48 and 0.71±0.56) were significantly higher than those 12mo after treatment (0.31±0.26 and 0.33±0.17) in groups A and B, respectively (P

AIM: To observe the efficacy of different dosage regimens of ranibizumab in the treatment of choroid neovascularization secondary to pathological myopia(PM-CNV), and to explore the related factors affecting retreatment.METHODS: The medical records of 42 patients(43 eyes)diagnosed with PM-CNV in our hospital from January 2015 to January 2020 and treated with intravitreal injection of ranibizumab were retrospectively analyzed. According to different dosage regimens, they were divided into group A(3+PRN, 22 cases with 22 eyes)and group B(1+PRN, 20 cases with 21 eyes). Followed up for 12mo, the changes of best corrected visual acuity(BCVA), central macular thickness(CMT)and choroidal neovascularization(CNV)were observed and compared between the two groups. The times of intravitreal injection, retreatment rate and recurrence rate after initial treatment were compared between the two groups, and the related factors affecting retreatment were analyzed.RESULTS: At 1,3,6 and 12mo, the BCVA(LogMAR), CMT and CNV thickness in the two groups were significantly improved compared with those before treatment(P300μm and baseline CNV area >1.0mm2 were all related factors affecting retreatment.CONCLUSION: Intravitreal injection of ranibizumab 1+PRN and 3+PRN can both effectively improve the visual prognosis and anatomical structure of PM-CNV patients, but the 1+PRN treatment has less injection times than the 3+PRN treatment, which reduces the risk and cost of treatment.

Background: We retrospectively evaluate the long-term efficacy and safety of trabeculotomy glaucoma surgery in treating open-angle glaucoma (OAG) in eyes with high myopia (HM). Methods: This study included 20 eyes with HM (axial length ≥ 26.5 mm) and OAG; age, preoperative IOP (intraocular pressure), and sex-matched 20 non-HM eyes (axial length < 26.5 mm) served as controls. Each eye underwent standalone ab interno trabeculotomy using a Kahook dual blade. A follow-up examination was performed 36 months after surgery. The main outcome measure was the operative success rate (i.e., a ≥ 20% pre- to post-operative reduction in IOP with or without IOP-lowering medication). Kaplan–Meier analysis was employed as a measure of surgical success. The secondary outcome measures were postoperative IOP, the number of glaucoma medications, and postoperative complications. Results: IOP and the number of glaucoma medications were statistically significantly reduced at all postoperative follow-up examinations. The Kaplan–Meier analysis demonstrated that the probability of postoperative success at 36 months was 45% and 65% for HM and non-HM eyes, respectively. In the HM group, the presence of pathological myopia was statistically significant risk factor for surgical failure. No critical postoperative complications were detected. Conclusions: In our study, the long-term efficacy of ab interno trabeculotomy in HM eyes with OAG was inferior to that in non-HM eyes with OAG. Our findings suggest that surgical indications for trabeculotomy in HM should be determined based on the presence of pathological myopia. [ABSTRACT FROM AUTHOR]

Objective: To analyze changes in retrobulbar blood flow in patients with pathological myopia using color doppler ultrasound (CDU), and to explore the relationship of these changes with the characteristic changes resulting from myopia. Methods: One hundred and twenty patients who met the selection criteria in the ophthalmology department of He Eye Specialist Hospital from May 2020 to May 2022 were included in this study. Patients with normal vision (n=40) were considered Group-A, patients with low and moderate myopia (n=40) were considered Group-B, and patients with pathological myopia (n=40) were considered Group-C. All three groups underwent ultrasonography. The peak systolic blood flow velocity (PSV), end-diastolic blood flow velocity (EDV), and resistance index (RI) of the ophthalmic artery, central retinal artery, and posterior ciliary artery were recorded and compared, and the characteristics of these parameters and myopia severity were analyzed. Results: Pathological myopia resulted in significantly lower PSV and EDV of the ophthalmic artery, central retinal artery and posterior ciliary artery and higher RI values than patients with normal vision and low/moderate myopia (P<0.05). Pearson correlation analysis showed that retrobulbar blood flow changes were significantly correlated with age, eye axis, best corrected visual acuity, and retinal choroidal atrophy. Conclusion: CDU can objectively evaluate the retrobulbar blood flow changes in pathological myopia, and such blood flow changes are significantly correlated with the characteristic changes of myopia. [ABSTRACT FROM AUTHOR]

PurposeThe purpose of this study was to suggest a novel approach to assessing the activity of macular neovascularization (MNV) in pathological myopia (PM) by comparing optical coherence tomography (OCT) with OCT-angiography (OCT-A).MethodsThe Zeiss Cirrus HD-5000 was used to obtain OCT and OCT-A images of PM-MNV. The objective was to examine the characteristics of PM-MNV lesions and investigate the relationship between PM-MNV activity and changes in retinal structure in 54 patients (54 eyes). To analyze the OCT parameters associated with PM-MNV activity and their clinical significance in terms of sensitivity and specificity, we used OCT-A as a reference.ResultsThis study included 72 patients (72 eyes), of whom 54 had good image quality and were considered for analysis. The study evaluated various OCT characteristics of MNV lesions, including the elevation of an external limiting membrane (ELM), ellipsoidal zone (EZ), retinal pigment epithelium (RPE) elevation, and EZ/RPE interruption, to identify possible parameters associated with PM-MNV activity. The interobserver consistency was found to be almost perfect. In the evaluation of PM-MNV activity, the sensitivity of ELM elevation, EZ interruption, and RPE interruption was found to be 66.7% (low), 88.4% (high), and 95.6% (high), respectively. However, the specificity was found to be 71.4% (moderate), 71.4% (moderate), and 25.4% (poor), respectively. This indicates that the current evaluation methods are not accurately assessing PM-MNV activity. We developed a new comprehensive method that used EZ interruption as the primary parameter and ELM elevation and RPE interruption as secondary parameters to evaluate PM-MNV activity with a sensitivity of 97.8% and a specificity of 85.4%.ConclusionIn PM-MNV, a novel comprehensive diagnostic method combining EZ interruption, ELM elevation, and RPE interruption might be a valuable indicator to evaluate PM-MNV activity.

Aim We aimed to compare the anatomical and visual response of newly diagnosed choroidal neovascularization (CNV) secondary to pathological myopia or agerelated macular degeneration with relatively poor initial vision to treatment with three intravitreal injections of ranibizumab. Patients and methods This prospective, comparative study included 29 eyes of 29 patients newly diagnosed with subfoveal active CNV, either secondary to age-related macular degeneration (AMD-CNV, 15eyes) or to pathologicalmyopia, that is, myopicCNV(MCNV, 14eyes). All patients had an initial best-corrected visual acuity (BCVA) equal to or worse than 1.00LogMar. Patients receivedthreeintravitreal injectionsof 0.50mgranibizumabon a monthly basis. Patients were evaluated before injections and one month after each injection for BCVA and optical coherence tomography-measured retinal parameters: central macular thickness, total volume, and average thickness (AT). Amsler's chart was used to detect scotomas and metamorphopsias. Results One month after the three injections, a significant improvement was noted in the two groups in central macular thickness, total volume, and AT. The improvement was significantly better in AT of the AMD group. The mean BCVA improved significantly in the AMD group only as patients either improved or remained stationary, whereas in the MCNV group, 21% of patients deteriorated, which affected the significance of the overall mean of improvement (P=0.7823); the difference in the overall mean was insignificant. Despite that, almost half of the patients in each group had their visual acuity improved by an average of 9.5 letters in AMD and 10.7 in MCNV. Conclusion Naïve AMD-CNV and MCNV of initially poor VA can get significant improvement in all optical coherence tomography-measured retinal parameters following a threeinjection course of ranibizumab on a monthly basis. VA improvement is more predictable in AMD, as no patients deteriorated after the injections, yet the overall difference in VA improvement between groups was insignificant. [ABSTRACT FROM AUTHOR]

Introduction: To investigate the feasibility and safety of scleral ultraviolet A (UVA) cross-linking (scleral CXL) on pathologically blindness. Methods: This was a prospective, observational clinical study. Five patients with monocular blindness due to pathological myopic maculopathy were enrolled. Eyes with best corrected visual acuity (BCVA) under 0.05 were defined as experimental eyes. The fellow eyes were defined as control eyes. Patients first underwent posterior scleral reinforcement (PSR) surgery in the control eye. Thereafter, scleral CXL surgery was performed in the experimental eye on the same day. Visual acuity, BCVA, slit lamp biomicroscopic examination, intraocular pressure measurement, corneal specula microscopies, axis length measurement, funduscopy with pupil dilation, color fundus photography, full-field flash electroretinography, optical coherence tomography, and color Doppler flow imaging were performed at baseline, 1 week, 1 month, 3 months, 6 months, and 12 months after surgery. Results: No signs of inflammation were observed after operation and throughout the follow-up period. Retinoschisis was improved, while choroidal neovascularization fibrosis and retinal and choroidal atrophy were unchanged after scleral CXL. There were no statistically significant differences in the ophthalmic artery, central retinal artery, and posterior ciliary artery parameters of color Doppler flow imaging or in retinal thickness, within experimental and control eyes, at baseline, 1 week, 1 month, 3 months, or 12 months (P > 0.05). Conclusions: This pilot study verified the feasibility and safety of scleral CXL on human blindness. The UVA-CXL on the sclera of human eyes seems to have the same effect as PSR in preventing progressive pathological myopia in the future. Trial Registration: Chinese Clinical Trial Registry (ChiCTR2100042422). [ABSTRACT FROM AUTHOR]

Purpose: Myopic scleral pit (MSP) is a rare physical sign of pathological myopia (PM). The aim of this study was to summarize the clinical characteristics of MSP and analyze its correlation with PM. Methods: Eight cases with PM and MSP were enrolled in this study. Comprehensive ophthalmic examinations, including subjective refraction, slit-lamp biomicroscope, intraocular pressure, fundus photographs, A- and B-scan ultrasonography and spectral-domain optical coherence tomography, were performed. Results: All the patients had a long history of PM with visual impairment, long axial length, and myopia-related fundus degeneration. Mean axial length was 31.48 ± 2.17 mm. Mean size of MSP was 0.69 ± 0.29 optic disc diameter (PD). Mean logMAR BCVA was 1.21 ± 0.88 logMAR. Spearman correlation analysis showed that the logMAR BCVA had no correlation with the size of pits (P = 0.34). Fundus examination revealed a focal pale concave located in the sclera exposed area of retinal choroid atrophy was found in all cases. OCT showed a deep scleral pit where the retinal choroid was thin or absent, without retinal sensory detachment or sensory defect. Conclusions: This study identified a rare scleral lesion in all eight individuals with PM, which was termed "myopic scleral pit". This phenomenon is different from focal choroidal excavation and posterior staphyloma. [ABSTRACT FROM AUTHOR]

Background: Choroidal neovascularization (CNV) occurs in as much as 11.3% of patients with pathological myopia, and is a major cause of visual disability associated with irreversible loss of central vision. The advent of optical coherence tomography angiography (OCTA) has opened up new opportunities for objective documentation and real-time qualitative and quantitative evaluation of CNV in the course of therapy. Purpose: To assess the efficacy of anti-vascular epithelium growth factor (VEGF) therapy with ranibizumab in CNV associated with pathological myopia using OCTA. Material and Methods: Thirty seven anti-VEGF-treatment naive patients (37 eyes) with myopic CNV were involved in the study. All study participants received an intravitreal ranibizumab injection (in accordance with the manufacturer’s recommendations) followed by as needed (PRN) retreatment. Results: Complete subretinal fluid resorption with adherence of the neurosensory retina was observed in all the 37 eyes; the mean number of intravitreal ranibizumab injections required was 4.56 ± 0.1. Over the 18-month follow up period, best-corrected visual acuity (BCVA) improved from 0.12 ± 0.03 to 0.42 ± 0.04 in 27 eyes (72.97%). OCTA patterns of CNV activity tended to fade, with the characteristic presence of isolated long filamentous vessels having a “dead tree” appearance. Conclusion: Application of OCTA, an information-rich modality, in pathological myopia, facilitates a personalized approach to determining the need for anti-VEGF therapy and selecting the mode of administration of anti-VEGF agents based on the CNV activity.

AIM:To observe the imaging features of optical coherence tomography angiography(OCTA)in the macular hemorrhage of pathologic myopia.METHODS:Designing a retrospective analysis collected clinical data of 100 patients(108 eyes)diagnosed as macular hemorrhage of pathological myopic in Nanjing Medical University Affiliated Eye Hospital from June 2016 to December 2020. All patients underwent refraction, eye axis,fundus photography, spectral-domain optical coherence tomography(SD-OCT), fundus fluorescein angiography(FFA), indocyanine green angiography(ICGA)and OCTA examination. All patients were divided into macular hemorrhage only with lacquer cracks and macular hemorrhage with choroidal neovascularization(CNV). All patients followed-up for more than 3mo by OCTA. RESULTS:There were 40 patients(42 eyes)diagnosed as macular hemorrhage only with lacquer cracks, OCTA showed bleed obscured by choroidal capillaries. After hemorrhage was being absorbed, lacquer cracks showed linear or stellate reflection completely in the choroidal capillary layer. B-scan image showed discontinuous retinal pigment epithelium(RPE), thinner choroid and an increased light. Penetrance into deeper tissues. After all macular hemorrhage only with lacquer cracks were absorbed, follow-up mode of OCTA found that 2 eyes(4.8%)without lacquer cracks, 28 eyes(66.7%)were linear and 12 eyes(28.6%)were stellate under the original hemorrhage. Follow-up mode also showed that 8 eyes of 8 patients(19.0%)relapsed macular hemorrhage only with lacquer cracks, and 4 eyes of 4 patients(9.5%)suffered secondary macular hemorrhage with CNV. There were 60 patients(66 eyes)diagnosed as macular hemorrhage with CNV,OCTA showed bleed obscured choroidal capillaries, the outer retinal and choroidal capillary layer also showed the shape of CNV around hemorrhage. B-scan showed CNV breaked through the RPE layer and blood flow signal in it. The area of CNV decreased after anti-vascular endothelial growth factor(VEGF)intravitreal injection treatment. Around all macular hemorrhage with CNV, OCTA found that 48 eyes(72.7%)had lacquer cracks, 28 eyes(42.4%)were linear and 20 eyes(30.3%)were stellate.CONCLUSION:OCTA has a great significance in the diagnosis of macular hemorrhage of pathological myopia, fast and non-invasive is the biggest advantage. Choroidal capillary layer can clearly observe the shape and location of hemorrhage,lacquer cracks and CNV. The follow-up mode can intuitively comprehend the changes of disease. To some extent, it can replace fundus angiography to directly judge the classification, and time to treat in the clinic.

The rising prevalence of myopia is a major global public health concern. Economic evaluation of myopia interventions is critical for maximizing the benefits of treatment and the healthcare system. This systematic review aimed to evaluate the cost-effectiveness of interventions for treating myopia. Five databases were searched – Embase, Emcare, PubMed, Web of Science, and ProQuest – from inception to July 2022 and a total of 2,099 articles were identified. After careful assessments, 6 studies met the eligibility criteria. The primary outcomes of this systematic review were costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER). The secondary outcomes included utility values and net monetary benefits (NMB). One study determined the cost-effectiveness of photorefractive screening plus treatment with 0.01% atropine, 2 studies examined cost-effectiveness of corneal refractive surgery, and 3 studies evaluated cost-effectiveness of commonly used therapies for pathologic myopia. Corneal refractive surgeries included laser in situ keratomileusis (LASIK), femtosecond laser-assisted in situ keratomileusis (FS-LASIK), photorefractive keratectomy (PRK), and small-incision lenticule extraction (SMILE). Interventions for pathologic myopia included ranibizumab, conbercept, and photodynamic therapy (PDT). At an incremental cost of NZ$ 18 (95% CI 15, 20) (US$ 11) per person, photorefractive screening plus 0.01% atropine resulted in an ICER of NZ$ 1,590/QALY (US$ 1,001/QALY) (95% CI NZ$ 1,390, 1,791) for an incremental QALY of 0.0129 (95% CI 0.0127, 0.0131). The cost of refractive surgery in Europe ranged from €3,075 to €3,123 ([US$4,046 to $4,109 - adjusted to 2021 inflation). QALYs associated with these procedures were 23 (FS-LASIK) and 24 (SMILE and PRK) with utility values of 0.8 and ICERs ranging from approximately €14 (US$17)/QALY to €19 (US$23)/QALY. The ICER of LASIK was US$683/diopter gained (inflation-adjusted). The ICER of ranibizumab and PDT were £8,778 (US$12,032)/QALY and US$322,460/QALY respectively, with conbercept yielding a saving of 541,974 RMB (US$80,163)/QALY, respectively. The use of 0.01% atropine and corneal refractive surgery were cost-effective for treating myopia. Treating pathologic myopia with ranibizumab and conbercept were more cost-effective than PDT. Prevention of myopia progression is more cost-effective than treating pathologic myopia.

Purpose: We aimed to investigate the longitudinal change in the number of surgically operated myopic traction maculopathies (MTM) cases at a tertiary eye centre. Methods: A retrospective study of all consecutive cases of surgically operated MTM over 12 years (2009-2020) was conducted in a myopia prevalent region. We compared outcomes among three groups: (1) myopic macular hole (MH), (2) myopic macular hole with retinal detachment (MHRD), and (3) myopic foveoschisis with retinal detachment (MFRD). Results: Fifty-one cases were included in the study (8 cases of MH, 33 cases of MHRD and 10 cases of MFRD). The overall mean age was 63.8 +/- 8.7 with a female preponderance (2:1). The mean age of the MH group (58.6) was significantly younger than the MHRD group (64.2) and MFRD group (66.6) (p = 0.02). Subgroup analysis using ATN classification did not show its correlation with both visual improvement and anatomical success. When comparing the first 6-year period (2009-2014) with the second 6-year period (2015-2020), there was a significant increase in the number of cases (p = 0.01). Conclusion: We observe an increase in the number of surgically operated MTM. This follows the trend of the global rise in the prevalence of myopia and baby boomers entering retirement. [ABSTRACT FROM AUTHOR]

Background: In recent years, with the rapid development of machine learning (ML), it has gained widespread attention from researchers in clinical practice. ML models appear to demonstrate promising accuracy in the diagnosis of complex diseases, as well as in predicting disease progression and prognosis. Some studies have applied it to ophthalmology, primarily for the diagnosis of pathologic myopia and high myopia-associated glaucoma, as well as for predicting the progression of high myopia. ML-based detection still requires evidence-based validation to prove its accuracy and feasibility., Objective: This study aims to discern the performance of ML methods in detecting high myopia and pathologic myopia in clinical practice, thereby providing evidence-based support for the future development and refinement of intelligent diagnostic or predictive tools., Methods: PubMed, Cochrane, Embase, and Web of Science were thoroughly retrieved up to September 3, 2023. The prediction model risk of bias assessment tool was leveraged to appraise the risk of bias in the eligible studies. The meta-analysis was implemented using a bivariate mixed-effects model. In the validation set, subgroup analyses were conducted based on the ML target events (diagnosis and prediction of high myopia and diagnosis of pathological myopia and high myopia-associated glaucoma) and modeling methods., Results: This study ultimately included 45 studies, of which 32 were used for quantitative meta-analysis. The meta-analysis results unveiled that for the diagnosis of pathologic myopia, the summary receiver operating characteristic (SROC), sensitivity, and specificity of ML were 0.97 (95% CI 0.95-0.98), 0.91 (95% CI 0.89-0.92), and 0.95 (95% CI 0.94-0.97), respectively. Specifically, deep learning (DL) showed an SROC of 0.97 (95% CI 0.95-0.98), sensitivity of 0.92 (95% CI 0.90-0.93), and specificity of 0.96 (95% CI 0.95-0.97), while conventional ML (non-DL) showed an SROC of 0.86 (95% CI 0.75-0.92), sensitivity of 0.77 (95% CI 0.69-0.84), and specificity of 0.85 (95% CI 0.75-0.92). For the diagnosis and prediction of high myopia, the SROC, sensitivity, and specificity of ML were 0.98 (95% CI 0.96-0.99), 0.94 (95% CI 0.90-0.96), and 0.94 (95% CI 0.88-0.97), respectively. For the diagnosis of high myopia-associated glaucoma, the SROC, sensitivity, and specificity of ML were 0.96 (95% CI 0.94-0.97), 0.92 (95% CI 0.85-0.96), and 0.88 (95% CI 0.67-0.96), respectively., Conclusions: ML demonstrated highly promising accuracy in diagnosing high myopia and pathologic myopia. Moreover, based on the limited evidence available, we also found that ML appeared to have favorable accuracy in predicting the risk of developing high myopia in the future. DL can be used as a potential method for intelligent image processing and intelligent recognition, and intelligent examination tools can be developed in subsequent research to provide help for areas where medical resources are scarce., Trial Registration: PROSPERO CRD42023470820; https://tinyurl.com/2xexp738., (©Huiyi Zuo, Baoyu Huang, Jian He, Liying Fang, Minli Huang. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 03.01.2025.)

In today's era, precise and timely diagnosis of ocular diseases are crucial as these disorders jeopardize millions of visions. Early detection and proactive management can minimize vision threatening complications from these disorders. High Myopia(HM) and Pathological Myopia(PM), are the globally prevalent ocular diseases, which can impair vision acuity and productivity across all age groups. Routine screening via computer aided diagnosis(CAD) is required to detect HM and PM early and halt their progression. Previous studies majorly relied only on deep convolutional neural network(deep-CNN) features and independent analysis of PM and HM. This work seeks to provide a holistic analysis of PM and HM pathology by creating a novel ternary classifier on colour fundus images to detect normal vision, PM and HM respectively. We built the classifier by integrating texture features generated using gray level co-occurrence matrix(GLCM) within the deep-CNN model. Deep-CNN model comprises of spatial attention(SA) to locate lesion, squeeze-excitation(SE) to model interdependent channel attention & atrous or dilated convolutions to capture salient multiscale features of the related disease. Investigations employing extensive ablation techniques have elucidated the significance of optic disc(OD) and retinal vessel(RV) in the fundus images and their respective alterations in the HM or PM fundus. On the diverse dataset of 3212 colour fundus images, our ternary classifier has achieved 5-fold cross validation mean accuracy of 0.9754(+/-0.014), test accuracy of 0.9767 on 645 test fundus images and the kappa score of 0.9622 indicating the clinical viability of our classifier. The performance of our classifier excelled that of other pertinent studies for both PM and HM colour fundus images. Our classifier's test findings, comprehensive aetiology analysis and class activation maps are validated by the expert ophthalmologists making it reliable to serve as a virtual doctor alleviating the concerns with the lack of skilled ophthalmologists and expensive optometry tools by facilitating remote diagnostics and telemedicine applications., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Pathological myopia (PM) is associated with ocular morbidities that cause blindness. PM often occurs in eyes with high myopia (HM) while they are distinctly different. Identifying the differences in metabolites and metabolic pathways between patients with PM and HM may provide information about the pathogenesis of PM, which is currently unknown. This study aimed to reveal the comprehensive metabolic alterations associated with PM. Thirty patients with PM, 27 with simple HM and 27 with low myopia (LM) were enrolled in this study. Ultra-performance liquid chromatography/tandem mass spectrometry (UPLC-MS/MS) was performed, and a Venn diagram was generated to explore the overlapping differential metabolites and enriched pathways between each set of two groups. The area under the receiver operating characteristic curve (AUC) was computed to assess the discrimination capacity of each metabolite marker. A total of 134, 125 and 81 differential metabolites were identified in each comparison. Thirty-two differential metabolites were overlapped between the PM vs HM comparison and the PM vs LM comparison. Of these 32 metabolites, 16 were common to all three comparisons; among these metabolites, high levels of 4-hydroxy-l-glutamic acid and low levels of succinic semialdehyde and 2,3-dinor-8-iso prostaglandin F2α appeared to be risk factors for PM. The remaining 16 metabolites were shared only between the PM versus HM and PM versus LM comparisons, most of which are lipid molecules. Pathway analysis revealed that alanine, aspartate and glutamate metabolism was the key metabolic pathway altered in PM patients. Overall, significant differences in the metabolites and metabolic pathways were observed in patients with PM. The metabolic differences identified in this study included differential factors between PM and HM patients, addressing current gaps in PM research. These findings provide a novel perspective of the molecular mechanism of PM., Competing Interests: Declaration of competing interest The authors declare that there are no competing interests associated with the manuscript., (Copyright © 2024. Published by Elsevier Ltd.)

Purpose: To report the long-term anatomical and functional results of macular buckle for Myopic Traction Maculopathy (MTM) in stages 3a, 3b, 4a, and 4b according to the MTM Staging System (MSS)., Methods: Retrospective observational cohort study involving 55 consecutive patients with MTM in stages 3a, 3b, 4a, and 4b who underwent macular buckle (MB). Postoperative outcomes, including optical coherence tomography (OCT) scans to evaluate the MTM stage and its progression, were evaluated 1-month postoperatively (i.e., "intermediate follow-up") and at last follow-up ranging between 6 and 156 months postoperatively (i.e., "final follow-up")., Results: Fifty-five eyes affected by MTM who underwent MB were enrolled. The mean preoperative and postoperative axial length was 31.13 ± 2.14 and 29.73 ± 2.16 mm, respectively (p < 0.01), with a mean axial shift of 1.32 ± 0.77 mm. The mean sample best corrected visual acuity (BCVA) at baseline, intermediate, and final follow-ups was 0.87 ± 0.36, 0.73 ± 0.31, 0.41 ± 0.32 logMar, respectively (p < 0.01). Foveal and retinal anatomical improvements were achieved in 50 (91%) and 53 (96.4%) eyes at intermediate follow-up, respectively. In the final follow-up, 54 (98.2%) and 55 (100%) eyes showed foveal and retinal anatomical improvements, respectively., Conclusions: MB as a single procedure, when applied to MTM in stages 3a, 3b, 4a, and 4b, leads to significant anatomical and functional improvement. The MTM Staging System allows us to evaluate the best surgical technique and the surgical timing tailored to the different stages to increase the surgery's success and lower the complications of each technique., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: To report the anatomic and visual outcomes following macular buckling in patients affected by pathological myopia-associated foveoschisis (FS) and macular detachment with or without macular hole (MH). Methods: A retrospective interventional consecutive case series wherein 25 highly myopic eyes (mean axial length 28.46 mm; range, 25–33.8 mm) of 24 patients (16 females and 8 males; mean age 54.1 years; range, 35–74 years) presenting with macular detachment associated with a posterior staphyloma (PS), who underwent macular buckling, were evaluated. Patients with absence or reduction in subretinal fluid by more than 90% during the final follow-up along with inversion of contour of staphyloma were considered to have a successful anatomical outcome and those with improvement or maintenance in visual acuity were considered to have a successful functional outcome. The mean duration of follow-up was 11.2 months. Results: At the time of initial presentation, the mean age of the 24 patients was 54.1 ± 10.28 years. Macular detachment along with FS was present in all cases, whereas full-thickness macular hole-related retinal detachment was present in nine cases. Swept-source optical coherence tomography parameters showed reduction of FS with foveal reattachment in all eyes except one at last visit. Mean axial length decreased from 28.5 mm preoperatively (range 26–33.8 mm) to 26.2 mm (range 24–29.3 mm). The mean best-corrected visual acuity changed from 1.16 log MAR to 1.096 Log MAR (P = 0.165). Visual acuity improved in 10 eyes (40%), remained stable in 11 eyes (44%) and decreased in 4 eyes (16%). Conclusion: Macular buckling is a good surgical technique with encouraging anatomic and visual outcomes in patients with myopic macular detachment associated with PS. Highly selective cases of myopic traction maculopathy can have a viable option of macular buckle surgery in stabilizing the retinal tractional changes, and thereby, vision loss.

Background and aim Pathological myopia (PM) is one of the main causes of blindness globally, and its prevalence continues to increase rapidly over time. The aim of this study was to investigate the prevalence of PM in the clinical population in Assiut City, Upper Egypt, during a period of 1 year. Patients and methods This cross-sectional study was carried out on a clinical population attending a large ophthalmology center in Assiut City, Upper Egypt, during the period from January to December 2018. All patients were subjected to full ophthalmologic examination. The noncycloplegic refraction was measured using an autorefractometer. The examined eyes were diagnosed as PM if they had refraction of more than or equal to −6 D spherical equivalent or an axial length of more than or equal to 25.5 mm. Results The study included 1548 eyes of 812 patients. Pathologically myopic eyes represented 152 eyes, with a prevalence of 9.82%. Of the total included patients, 102 (12.6%) patients had at least one pathologically myopic eye. Patients with bilateral PM represented 73 (71.6%) cases. Their refractive error ranged from −6.0 to −26.0 D, with a mean of −13.24±4.13 D, and their mean axial length was 28.2±2.14 mm and ranged from 26.1 to 35.2 mm. Conclusion The prevalence of PM in the studied sample was 9.82%, which was obviously higher compared with studies on other populations. Further large community-based studies are warranted to determine its prevalence as a step to overcome this true burden.